Contents - Middle East Journal of Family Medicine

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ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATION Table 5: Correct identification of the normal ECG’s plus acute MI by the different groups. Groups SFP, n (%) RFP, n (%) UP, n (%) SI, n (%) RI, n (%) Total Could not diagnose 14 (37.8) 11 (50.0) 16 (53.3) 6 (30.0) 13 (41.9) 60 (42.9) Could diagnose 23 (62.2) 11 (50.0) 14 (46.7) 14 (70.0) 18 (58.1) 80 (57.1) X 2 =3.54, P=0.47 SFM = Family Medicine Specialists, RFM = Family Medicine Residents, UP = Untrained Physicians, SIM = Internal Medicine Specialists, RIM = Internal Medicine Residents. Table 6: Non-response rates of the different groups. SFP, n (%) RFP, n (%) UP, n (%) SI, n (%) RI, n (%) X 2 , P ECG 1 2 (5.4) 4 (18.2) 8 (26.7) 0 (0) 0 () 17.4, 0.00 ECG 2 4 (10.8) 2 (9.1) 8 (26.7) 0 (0) 5 (16.1) 8.3, 0.08 ECG 3 2 (5.4) 5 (22.7) 7 (23.3) 0 (0) 2 (6.5) 11.6, 0.02 ECG 4 2 (5.4) 2 (9.1) 4 (13.3) 0 (0) 4 (12.9) 3.9, 0.41 ECG 5 7 (18.9) 8 (36.4) 16 (53.3) 3 (15.0) 9 (29.0) 12.3, 0.02 ECG 6 1 (2.7) 1 (4.5) 7 (23.3) 0 (0) 4 (12.9) 12.0, 0.02 ECG 7 4 (10.8) 0 (0) 6 (20.0) 1 (5.0) 3 (9.7) 6.3, 0.17 ECG 8 7 (18.9) 7 (31.8) 17 (56.7) 0 (0) 5 (16.1) 24.8, 0.00 ECG 9 25 (67.6) 10 (45.5) 18 (60.0) 7 (35.0) 19 (61.3) 7.1, 0.13 ECG 10 5 (13.5) 4 (18.2) 18 (60.0) 2 (10.0) 9 (29.0) 23.8, 0.00 Total 59 (15.9) 74 109 13 60 Diagnoses within each ECG: ECG 1: sinus tachycardia, right bundle branch block, and past MI; ECG 2: sinus bradycardia and left bundle branch block; ECG 3: sinus bradycardia and acute inferior MI; ECG 4: normal; ECG 5: left ventricle hypertrophy; ECG 6: atrial flutter; ECG 7: normal; was no statistically significant difference between groups with regard to correctly identifying two normal ECG sets plus acute MI (X 2 =3.54; p=0.471) (Table 5). Of the total sample, 54.2 % (n = 76) could correctly identify these three diagnoses. On the other hand, correct identification rates of the normal ECG’s and acute MI were 67.1 % (n = 94) and 85 % (n = 119) respectively. Median non-response rates of the groups were calculated. UP’s had the highest nonresponse rates followed by RI, SFP, RFP, and SI (Median non-response rates 3.5, 2, 1, 1, and 0 respectively) (Kruskal- Wallis X 2 =25.7, p
ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATION of family medicine. This finding supports our assumption on the insufficiency of undergraduate medical education to cover the clinical requirements of the graduates.The total of CS plus FS did not approach the total number of diagnoses (i.e. 16) in any group. This reveals that all groups, but especially the untrained physicians, have doubts in making a certain decision on the ECG sets. Although we expect somehow reverse findings in the results of false scores, untrained physicians represent an exception in this picture. Pacemaker is a rare diagnosis encountered in primary care [1]. We assume that the current undergraduate as well as postgraduate curricula of all groups in this study should be questioned with regard to teaching ECG reading skills. We conclude that especially physicians working at primary care positions have less chance to have patients with pacemakers, and are thus less successful in correctly identifying this diagnosis. Aspects Concerning Education These findings show that, graduates of medical faculties do not have the necessary qualifications for ECG interpretation. However, there is an agreement that the aim of medical education is to train graduates for some kind of specialisation, including family practice [9]. Hence, it is understandable that medical graduates are not ready to practice in primary care settings. The fact that medical graduates can work in primary care is the side of this problem, which might be a disadvantage for patients. Information seeking among primary care physicians is a problem for coping with the growing knowledge of medicine [10] Lack of obligations for continuous medical education may be an explanation for lower scores of untrained physicians. Another reason may be the relatively low availability of diagnostic tools including ECG in the Turkish primary health centres. Although internists have performed better than family physicians, both groups seem to have problems with ECG interpretation. One striking result of this study is that even the specialists of internal medicine could get a score of only 9.85 out of 16 (61.6 %). We suggest cardiology rotations of certain durations for all residency trainings where ECG reading skills are important. A curriculum focused especially on diagnoses prevalent for primary care should be applied to family practice residents, taking place in cardiology departments and primary care offices together. Structured training programs of ECG interpretation skills are in fact necessary for all clinical specialties dealing with the patient. Work experience should contribute to knowledge enhancement. However, given the fact that there is no correlation between work experience and total correct and false scores, we assume that work circumstances have no effect in improving the diagnostic skills, Limitations Although we tried to include the maximum sample size from each group, it was not possible to reach a nationally representative sample. Hence, this is just a study comparing different medical specialties. The samples of different groups were selected with similar characteristics with regard to sex, but the same is not true for age; specialists are older due to the time elapsed in residency education. On the other hand, there are some non-respondents, who might be assumed as different than the study population, but it is not possible to clarify this issue in this study setting. There is currently no standardised instrument to measure ECG reading skills. We developed our own instrument in the light of the literature and with the counselling of a cardiologist. Although particularly important for branches such as internal medicine, paediatrics, and family medicine, ECG reading is a skill necessary for all clinicians. To reveal a whole picture exposing the different factors on the degree of ECG reading skills, studies covering all physician groups with higher sampling rates should be conducted. A standardised ECG set can be developed for this purpose in order to help researchers from different nations to plan studies enabling international comparison. CONCLUSION This study has demonstrated that family practice residency education contributes to ECG interpretation skills. Beyond that the skills are not satisfactory enough, we do not think that formal education has much contribution to this effect. Personal efforts and the efforts of individual educators probably have much more effect in this matter. We think that the addition of formal cardiology training in family practice residency education will help to close the gap between internists and family practitioners. This study also supports the fact that primary care physicians must have special training in accordance with international standards in order to work in the field. There is a need to improve the ECG interpretation skills of medical undergraduates supported by appropriate postgraduate education. REFERENCES 1. Froom J, Froom P. Electrocardiogram abnormalities in primary care patients. J Fam Pract 1984;18(2):223-5. 2. Rutten FH, Kessels AGH, Willems FF, Hoes AW. Electrocardiography in primary care; is it useful Int J Cardiol 2000;74(199-205). 3. Sur DKC, Kaye L, Mikus M, Goad J, Morena A, MD. Accuracy of Electrocardiogram Reading by Family Practice Residents. Fam Med 2000;32(5):315-9. 4. Margolis S, Reed R. ECG analysis skills of family practice residents in the United Arab Emirates: a comparison with US data. Fam Med 2001;33(6):447-52. 5. Trzeciak S, Erickson T, Bunney EB, Sloan EP. Variation in patient management based on ECG interpretation by emergency medicine and internal medicine residents. Am J Emerg Med 2002;20(3):188-195. 6. Grauer K, ECG interpretation remains an important skill. Family Medicine 2000;32(8):519-20. 7. Gorpelioglu S, Korkut F, Aytekin F. Family practice in Turkey. Fam Pract. 1995 Sep;12(3):339-40 8. Topalli R, Topsever P, Filiz TM, Cigerli O, Gorpelioglu S. Hereke Family Practice Center, 2001: Evaluation of the Reasons for Office Visits and Referrals. Turkish Journal of Family Practice 2003;2:22-6. 9. The evolution and evaluation of a clinical clerkship in family medicine. McWhinney IR, Molineux JE, Hennen BK, Gibson GA J Fam Pract 1977 Jun;4(6):1093-9. 10. Nylenna M, Aasland OG. Primary care physicians and their information-seeking behavior. Scan J Prim Health Care 2000;18:9-13. MEJFM - Volume 3 Issue 5 - November 2005 10
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Page 31: CME QUIZ ECG interpretation quiz Te

Contents - Middle East Journal of Family Medicine

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